The electronic medical record: Learning to swim
While Dr. J. Timothy hanlon raises compelling issues about electronic medical records (EMRs),1 I think that his goslow approach can lead to lost opportunities. The push toward implementing EMR systems does not amount to a dangerous dive into a shallow pool. Rather, we should be optimistic that we are just learning to swim.
Addressing these concerns during these early years of the EMR is constructive and necessary. But his commentary may leave physicians wondering what to do. Should the EMR be scrapped until it is fully developed outside the clinical realm? Is that goal even attainable? Are physicians who use EMR systems putting patient care and information security at risk? I believe there is a more positive way to look at each of the issues.
No new technology comes into the world 100% formed and vetted. The nature of progress is evolution based on experience, as unforeseen problems are corrected. Skepticism and vigilance are warranted, but so is optimism.
CONNECTIVITY WILL IMPROVE
Dr. Hanlon notes that many EMR systems are available and that, at this point, they do not communicate with one another. That is often true. But Google, Microsoft, and others are working on the issues of connectivity and “portability” of the EMR. It is reasonable to expect that eventually there will be winners and losers, just as when VHS won out over Beta in the early days of video recording. More efficient sharing of information will eventually be possible. It would be counterproductive to legislate a single EMR system nationwide before a number of EMRs can be fully tried and tested in the trenches of patient care.
In the meantime, it is no harder—in fact, it is easier than ever—for one physician to send information to another, either by printing it out and mailing or faxing it or by e-mailing it. Furthermore, that information is much more legible than the handwritten records we continue to receive from physicians who do not use EMRs.
Therefore, while one can criticize the current lack of complete intersystem communication, this is only a temporary limitation, and developing complete interconnectivity of EMR systems is a key goal.
STAYING VIGILANT ABOUT SECURITY
The security of EMRs has always been a concern. However, improvements in security have prevented a large-scale privacy breach since an incident in 2006 in which a laptop computer containing information on 26.5 million people was stolen from the home of a Veterans Administration employee.2 For instance, Cleveland Clinic recently encrypted all of its laptop computers containing patient data, to protect patient information should a laptop be lost or stolen. This is only one of many security innovations that are being implemented. While we must remain highly vigilant and continue to improve security, we must remember that the paper chart is not immune to privacy breaches either, and when paper charts were stolen, the medical record was irretrievably lost and was not reproducible. This is not the case with the EMR.
QUALITY OF CARE IS PARAMOUNT
As Dr. Hanlon accurately notes, evidence that the EMR improves the quality of care is mixed so far. He is concerned that most of the studies showing improved outcomes came from “benchmark” institutions, and that the results may not be broadly applicable. Such pessimism is unwarranted, given that the EMR is in its relative infancy and the motivation to improve quality of care is paramount, especially in this era of health care reform. While benchmark institutions are in an ideal position to do the studies on quality, there is no reason to assume that the results will not be applicable to other institutions as well.
